Non-vaccine aid for needy nations' pandemic response falls short

Jul 7, 2010 (CIDRAP News) – While donor countries and organizations have responded well to the need for pandemic flu vaccine for developing countries, the level of giving for other pandemic response efforts in needy countries so far has fallen short, the World Health Organization (WHO) said in a recent report.

The level of resources given for things like health system planning, healthcare worker training, strengthening communications, humanitarian readiness, and public-health decision-making has fallen well below the need that was estimated last fall, says the report, titled "Urgent Support for Developing Countries' Responses to the H1N1 Influenza Pandemic."

Following a formal assessment, last September the WHO estimated that 64 "least-resourced countries" needed a total of $1.48 billion of aid for vaccine, medicines and supplies, laboratory and surveillance services, communications capacity, and other activities to respond to the pandemic.

But the report acknowledges that the estimate of need assumed that the pandemic would be more severe than it has turned out to be so far. "Since the virus has proven to be generally mild, it is likely that, in practice, the financial resources needed to respond to the H1N1 influenza pandemic are less than the amount originally requested," it states.

The report, completed Jun 30, is an update on contributions and activities from February through May of this year. The next report is scheduled to be issued in June 2011.

The amount needed for general preparedness (called "country readiness" in the report) was estimated at $237.8 million, but the amount contributed so far totals only $102.2 million, the report says. The only item for which resources have met the need, at $25.4 million, is lab capacity.

The other areas show shortfalls: for health system readiness, $79.5 million needed versus $34.4 million raised; communication, $58.5 million needed, $24.7 million raised; "whole of society" and humanitarian readiness, $58.4 million needed, $9.2 million raised; and situation assessment, $16 million needed, $8.5 million raised.

The report catalogs various general preparedness activities the WHO has carried out in developing countries in recent months. Some examples include UNICEF (United Nations Children's Fund) support for the updating of national communication strategies in India, Bangladesh, Egypt, and Malawi; UNICEF support for the Lao government's vaccine deployment strategy; and "training the trainer" pandemic preparedness programs for small and medium-size businesses in Thailand.

The report also gives an update on H1N1 vaccine donations to developing countries, covering some information from a report issued in June but offering more details. It says that donors have promised to provide 200 million doses of vaccine, of which 127.4 million doses have been received so far, including 7.7 million since February. Previous reports have said the WHO's goal was to provide enough vaccine for 10% of the populations of 95 developing countries. So far, 86 countries have requested vaccine and signed agreements with the WHO, the report notes.

Included is a list of vaccine donors and their contributions. GlaxoSmithKline and Sanofi Pasteur lead the list with 60 million and 20 million doses, respectively. Other donors are the United States, 15 million doses; France, 9.4 million; Canada, 5 million; the United Kingdom, 3.8 million; MedImmune, 3 million; CSL, 3 million; Italy, 2.4 million; Australia, 2.1 million; Switzerland, 1.5 million; Belgium, 1.26 million; and Norway, 940,000.

Along with vaccine, the WHO has received 45 million syringes and 500,000 safety boxes from the United States and 25 million syringes from AmeriCares. The vaccine doses and related supplies are valued at $335.7 million.

But to match the amount of vaccine pledged, the WHO still needs another 130 million syringes, according to the report. Also, another $14.6 million is needed to cover the cost of vaccine deployment, which is estimated at $62.6 million all told.

As for antiviral drugs, the WHO has distributed 4.7 million treatment courses of oseltamivir, donated by Roche, to 128 countries since the start of the pandemic, all of that before March of this year, the report says. There have been no new donations of antiviral drugs and no further distribution from WHO stockpiles since then. The original estimate of need for the drugs was 78 million treatment courses.

No countries have requested antibiotics to treat flu patients with bacterial complications, and no one has donated antibiotics to the WHO for use in the pandemic, according to the report. It was estimated last fall that 39 million treatment courses would be needed.

The report describes a number of mechanisms through which pandemic-related donations have reached needy countries, including direct contributions to the WHO Public Health Emergency Fund, contributions to other United Nations agencies, and direct contributions to governments.

Counting all of these mechanisms, the WHO estimates that a total of $536.2 million in cash and in-kind resources has been provided to help needy countries deal with the pandemic, according to a chart in the report. The largest item is the $335.7 million worth of vaccine and related supplies.

The second largest amount is $137.1 million that the WHO's Public Health Emergency Fund has received for vaccine deployment and global response since the start of the pandemic. That includes $15.4 million contributed since Feb 1.

The WHO estimates that donors have given $26.4 million directly to developing countries for pandemic response, but it says that the real total of this type of assistance is probably much greater.